California hospitals will still have patients if the health care bill proposed by U.S. Senate Republicans becomes law.

But instead of insured patients getting preventative care, many who lose coverage through Medicaid cuts will show up in dire shape at emergency rooms with no way to pay, imperiling hospitals’ finances along the way.

That’s the grim future foreseen by hospital executives as they read the Better Care Reconciliation Act, which could be voted on this month.

“Children’s Hospital Los Angeles would do everything it could to remain open, but we wouldn’t be able to keep our doors open without making substantial cuts,” hospital President and CEO Paul Viviano said in a news release from the office of Sen. Dianne Feinstein, D-Calif.

“I can’t see a scenario where hospitals would not be negatively impacted,” said Dr. Bradley Gilbert, CEO of Inland Empire Health Plan, a nonprofit group that coordinates services for more than 1.2 million Medi-Cal and Medicare enrollees in Riverside and San Bernardino counties.

It also imposes per-capita spending caps on what the federal government pays for Medicaid enrollees, a move opponents say amounts to a cut because the caps don’t keep pace with the rising cost of health care. The Senate bill’s Medicaid cuts are deeper than the House version, critics say, because a general inflation index – not one tied to health care – is used.

One in three California residents is on Medi-Cal – the state’s version of Medicaid – and Medi-Cal covers the majority of patients at a number of safety-net hospitals, including seven in 10 patients at Viviano’s hospital and more than 70 percent of patients at the county-run Riverside University Health System (RUHS) – Medical Center.

Like a similar bill that passed the House, the Senate bill phases out the Medicaid expansion started by the Affordable Care Act, also called Obamacare.

Nationwide, 22 million Americans, including 15 million on Medicaid, would lose coverage under the Senate bill by 2026, the CBO found.

It wasn’t clear Tuesday, July 11 whether the bill had enough votes to pass. Senate Majority Leader Mitch McConnell of Kentucky is trying to bridge the gap between GOP moderates concerned about Medicaid cuts and conservatives who want to end more Obamacare regulations. A revised version was reportedly coming out Thursday.

Republicans have expressed a desire to rein in Medicaid costs and give states flexibility to run the program while ensuring Medicaid serves only the neediest. That’s nonsense, say Democrats who contend the push to repeal Obamacare is really about giving a tax break to the wealthy.

‘Sicker over time’

About $3 billion in Medi-Cal costs would shift from Washington, D.C., to California by 2020 and the hit would grow to $30.3 billion by 2027, according to an analysis of the Senate bill by the state Department of Health Care Services.

The bill also removes an expansion of Medi-Cal’s “presumptive eligibility program” for hospitals by 2020. About 25,000 Californians each month are offered coverage through the program – it currently costs the state about $400 million – and by ending it, “costs will shift to hospitals and individuals that will no longer be found eligible for Medi-Cal,” the department found.

Gilbert said Medi-Cal cuts would leave the state with three options – make fewer people eligible, cut payments to providers or cut benefits to enrollees. Many insured by the Medi-Cal expansion have diabetes, high blood pressure and other chronic conditions that require preventative care, Gilbert added.

Access to health care and mental health services “is directly linked to a region’s educational and economic attainment,” said Jennifer Cruikshank, CEO of the RUHS hospital in Moreno Valley. “A repeal of the ACA without a plan to maintain the same level of coverage and quality of benefits would be a massive blow to the entire Inland region.”

If the Medi-Cal expansion ends, “many people will do what they historically did – forego regular medical treatment for illnesses and chronic diseases,” Cruikshank said. “They will grow much sicker over time and then turn to high-cost emergency rooms and hospitals for care. That’s not good for anyone.”

Cutting Medi-Cal could be especially troublesome for the RUHS hospital, which was losing $1 million a week a few years ago.

Its finances have since stabilized. But the hospital continues to rely on Medicaid and Medicare funding and receives very little from private insurance as it transitions from a purely safety-net facility to one that competes for patients in the health care marketplace.

A spokesman for KPC Health, which owns hospitals in Orange and Riverside counties, said the company is “monitoring the legislation in terms of its impact on reimbursement and looks forward to working with our local members of Congress to provide input on the final legislation.”

“Regardless of where things end up on Medicaid funding, hospitals appreciate Congress looking to reform Obamacare in a way that reduces health insurance premiums for working families that live within the communities we serve while protecting provider reimbursement,” Jeff Corless said.

KPC’s hospitals include the Orange County, Anaheim, Chapman and South Coast global medical centers and hospitals in Victor Valley, Hemet and Menifee.

By the Numbers

Here’s a look at Medi-Cal, a state/federal health insurance for low-income and disabled people.

14 million – the number of Californians on Medi-Cal. That comes out to one in three state residents.

$30.3 billion – the amount California would have to make up in Medi-Cal dollars by 2027 if the cuts proposed in the Better Care Reconciliation Act are enacted, according to the state Department of Health Care Services.

Seven in 10 – the number of patients covered by Medi-Cal at Children’s Hospital Los Angeles and Martin Luther King Jr. Community Hospital in Los Angeles, according to Sen. Dianne Feinstein, D-Calif. It’s a similar ratio at Riverside University Health System – Medical Center in Moreno Valley.

Jeff Horseman got into journalism because he liked to write and stunk at math. He grew up in Vermont and he honed his interviewing skills as a supermarket cashier by asking Bernie Sanders “Paper or plastic?” After graduating from Syracuse University in 1999, Jeff began his journalistic odyssey at The Watertown Daily Times in upstate New York, where he impressed then-U.S. Senate candidate Hillary Clinton so much she called him “John” at the end of an interview. From there, he went to Annapolis, Maryland, where he covered city, county and state government at The Capital newspaper before love and the quest for snowless winters took him in 2007 to Southern California, where he started out covering Temecula for The Press-Enterprise. Today, Jeff writes about Riverside County government and regional politics. Along the way, Jeff has covered wildfires, a tropical storm, 9/11 and the Dec. 2 terror attack in San Bernardino. If you have a question or story idea about politics or the inner workings of government, please let Jeff know. He’ll do his best to answer, even if it involves a little math.

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